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General NPI Number Information
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NPI Number | 1275589152
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Entity Type | Organization
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Legal Business Name | JOHN A WALSH MD PA
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 14 OFFICE PARK DR STE 7
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City | PALM COAST
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State | FL
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Zip | 32137-3830
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Country | US
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Telephone | 386-302-5064
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Fax | 386-302-5093
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Provider Business Mailing Address
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Address Line | PO BOX 17021
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City | BELFAST
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State | ME
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Zip | 04915-4065
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Country | US
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Telephone | 386-302-5064
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Fax | 386-302-5093
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ALAN WALSH
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Credential | MD
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Telephone | 386-328-0245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME78805
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License Number State | FL
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